A recent investigatory review has raised concerns about potential eye complications linked to the use of GLP-1 medications, notably semaglutide and tirzepatide. The review reports that nine individuals taking these drugs experienced significant vision issues, including a rare condition known as Nonarteritic Anterior Ischemic Optic Neuropathy (NAION). This condition, which affects blood flow to the optic nerve, can lead to irreversible vision loss. The study's findings have prompted calls for further research and increased caution among patients and healthcare providers.
Semaglutide and tirzepatide are the active ingredients in widely prescribed medications Zepbound and Mounjaro. In 2023, approximately 2-3% of the U.S. population received prescriptions for these treatments. The study, published in JAMA Ophthalmology, suggests a critical link between these drugs and the development of NAION. Researchers are also exploring other potentially blinding conditions associated with these medications, such as papillitis and paracentral acute middle maculopathy.
Bradley Katz, an ophthalmologist at the John A. Moran Eye Center and lead author of the study, emphasized the importance of monitoring patients using GLP-1 medications for vision changes.
“What we are recommending is that if you experience a change in your vision while using one of these drugs, you should consult the prescribing doctor and see an ophthalmologist. We are also recommending that if patients are starting these drugs or increasing the dose of these drugs, they should do so slowly to reduce the risk of dropping their blood sugar and causing an osmotic shift.” – Bradley Katz, MD, PhD
Katz further stated that a post-marketing survey is essential to determine the true incidence of eye complications related to these medications.
“We as well as other concerned physicians are also asking FDA to mandate a post-marketing survey of these drugs to find the true incidence of eye complications associated with them. We are in discussions with other groups around the U.S. who want to do a more comprehensive review of these medications and potential ocular side effects,” – Bradley Katz, MD, PhD
The study's lead author also pointed out that between 2-3% of the U.S. population received prescriptions for these medications in 2023.
“Between 2-3% of the U.S. population received a prescription for one of these medications in 2023,” – Bradley Katz, MD, PhD
Mir Ali, MD, a board-certified general surgeon and bariatric surgeon, offered additional insight into the implications of the study's findings.
“As with all medications, if a patient notices a significant change in vision, or any other system, they should contact their prescribing provider. Since there is widespread use of these medications, it is important for people to be aware of all potential side effects and complications. However, since eye problems are very rare, it probably would not impact the frequency people on these medications should have their eyes examined.” – Mir Ali, MD
Ali emphasized the rarity of such complications despite the widespread use of GLP-1 medications.
“This seems to be a rare and unusual complication of GLP-1 medication use, as millions of people have been using these types of medications for many years,” – Mir Ali, MD
However, Ali cautioned against dismissing potential risks outright.
“If a risk factor for eye problems is identified, and someone has these factors, then it may be a reason for a person to avoid these medications.” – Mir Ali, MD
The study revealed that seven participants developed NAION while taking semaglutide or tirzepatide. NAION is considered a relatively rare condition but poses severe risks due to its impact on optic nerve blood flow. The proposed mechanisms of injury put forward by researchers merit further investigation.
“The proposed mechanisms of ‘injury’ put forward by the authors are worthy of investigation,” – Krauss
Krauss also recommended regular eye exams for patients at risk.
“Frequent — at least annual — eye exams for those with underlying diseases which carry risk of adverse ocular sequelae, even in the absence of ocular or visual symptoms, are to be recommended.” – Krauss
For those seeking additional precautionary measures before starting treatment with GLP-1 medications, Krauss advised an initial eye exam.
“Those who wish to take an extra step of caution, may choose to have an eye exam prior to initiating treatment to determine their ocular health status and to query if they may have a ‘disc-at-risk,’ in that the large majority of those who may acquire NAION have a c/d ratio less than or equal to 0.3.” – Krauss
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